A Systematic Review and Meta-Analysis of Local Administration of 1 Percent Metformin as an Adjunct to Scaling and Root Planning on Periodontal Intrabony Defects

The Purpose: This systematic review conducted to assess the effectiveness of local administration of 1 % Metformin as an adjunct to scaling and root planing on periodontal intrabony defects. Methods: Two independents reviewers searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and ClinicalTrials.gov.We included randomized controlled trials (RCTs) of local administration of 1% metformin interventions in patients with periodontal intrabony defect undergoing scaling and root planing as compared to local administration of placebo gel where periodontal parameters were evaluated. The Cochrane RoB tool was used to evaluate the risk of bias. Meta-analyses for the quantitative data were performed. We assessed the level of certainty for our outcomes using (GRADE) tool. Results: Among the 1666 studies screened, two RCTs were included in the meta-analyses. The meta-analysis showed a statistically significant difference for all outcomes except the plaque index.Quantitative analyses showed a weighted mean difference (WMD) of1.17 mm (95% CI=1.01 to 1.34 mm, P<0.00001) for depth of periodontal intrabony defect; a WMD of 2.54 mm (95% CI=2.20 to 2.88 mm, P<0.00001) for clinical attachment level;a WMD of 2.01 mm (95%CI=1.68 to 2.33 mm, P<0.00001) for probing depth (PD);a WMD of 0.38 (95% CI=0.14 to 0.62, P = 0.002) for bleeding on probing (BOP); and a WMD of 0.00 mm (95% CI=−0.04 to 0.04 mm, P=0.95) for plaque index. There is moderate certainty of the evidence for all outcomes. Conclusions: Local application of 1% metformin in patients with periodontal intrabony defect may improve the clinical and radiographic periodontal parameters. Future clinical trials are required to confirm the clinical benefits of a 1% metformin application as adjunctive to scaling and root planing in patients with periodontal intrabony defect. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD167223.